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Dive into the research topics where Joanna M. Battagel is active.

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Featured researches published by Joanna M. Battagel.


Journal of Sleep Research | 2007

The relationship between craniofacial anatomy and obstructive sleep apnoea: a case-controlled study.

Ama Johal; Shivani I. Patel; Joanna M. Battagel

The aim of the study was to identify craniofacial and pharyngeal anatomical factors directly related to obstructive sleep apnoea (OSA). The design and setting was a hospital‐based, case‐controlled study. Ninety‐nine subjects (78 males and 21 females) with a confirmed diagnosis of OSA, who were referred to the Dental Hospital for construction of a mandibular advancement splint were recruited. A similar number of control subjects, matched for age and sex, were recruited after completing snoring and Epworth Sleepiness Scale questionnaires to exclude habitual snoring and daytime sleepiness. An upright cephalogram was obtained and skeletal and soft tissue landmarks were traced and digitized. In OSA subjects the anteroposterior skeletal measurements, including maxillary and mandibular length were reduced (P < 0.001). The intermaxillary space was found to be 3.1 mm shorter in OSA subjects (P = 0.001). The nasopharyngeal airway in OSA subjects was narrower (P < 0.001) but pharyngeal length showed no difference. The tongue size was increased (P = 0.021), soft plate length, thickness and area were all greater (P < 0.001) and the hyoid bone was more inferiorly positioned in OSA subjects (P < 0.001). This study identifies a significant number of craniofacial and pharyngeal anatomical factors directly related to OSA.


Journal of Laryngology and Otology | 2005

Sleep nasendoscopy as a predictor of treatment success in snorers using mandibular advancement splints.

Joanna M. Battagel; Ama Johal; Bhik Kotecha

This study assessed the effect on the upper airway during sleep nasendoscopy of mimicking the action of a mandibular advancement splint. Twenty-seven subjects with a diagnosis of sleep-disordered breathing were referred for mandibular advancement splint therapy following sleep nasendoscopy. Sleep nasendoscopy was repeated for all subjects with, and without, the appliance in situ. Follow-up sleep studies with a mandibular advancement splint in situ were undertaken for 19 individuals with significant obstructive sleep apnoea. With the mandibular advancement splint, subjective snoring levels and airway patency improved as predicted in all but one individual. Residual palatal flutter was predicted for five subjects and occurred in eight individuals. Follow-up sleep studies showed highly statistically significant reductions in median apnoea-hypopnoea index (from 28.1 to 6.1, p < 0.001). Mimicking the action of a mandibular advancement splint during sleep nasendoscopy helps considerably in the patient selection process for this form of treatment.


Journal of Laryngology and Otology | 2007

Impact of sleep nasendoscopy on the outcome of mandibular advancement splint therapy in subjects with sleep-related breathing disorders

Ama Johal; Mark P. Hector; Joanna M. Battagel; Bhik Kotecha

AIM To evaluate the impact of positive sleep nasendoscopy, with simultaneous mandibular advancement, on the outcome of mandibular advancement splint therapy in 120 subjects with sleep-related breathing disorders. METHODOLOGY Overnight polysomnography and sleep nasendoscopy were performed prior to splint therapy. Follow-up sleep studies, with the appliance in situ, were undertaken for those patients with obstructive sleep apnoea. Subjective outcome measures assessed daytime sleepiness and snoring. RESULTS One hundred and seven (89 per cent) subjects completed the study. Follow-up sleep studies confirmed the efficacy of treatment, with patients showing a mean reduction in apnoea/hypopnoea index (from 18.9 to 4.9, p<0.001), Epworth sleepiness scale scores (from 11 to seven, p<0.001) and partner-recorded snoring scores (from 14 to eight, p<0.001). CONCLUSION Sleep nasendoscopy, with concomitant mandibular advancement to mimic the treatment effect, could be of prognostic value in determining successful mandibular advancement splint therapy.


Journal of Orthodontics | 1996

Individualized Catenary Curves: Their Relationship to Arch Form and Perimeter

Joanna M. Battagel

Study casts of the lower arches of 35 children in whom arch alignment was considered acceptable, were examined using a reflex microscope. Arch perimeter was calculated mathematically from a method which required measurement of the mesio-distal widths of the teeth only. This was described as the ‘overlap’ method. Arch perimeter was also calculated using individualized catenary curves for each subject. Two calculations were made, recording arch width either at the distal contact points of the first permanent molars or between their mesio-buccal cusps. Arch perimeter measured from the length of the catenary curves was consistently shorter than that calculted by the overlap method. The variation ranged from 0·02 to 4·58 mm. The catenary constructed using the distal molar contacts gave a better representation of the actual arch form: the mean discrepancy was 2·36 mm, compared with 2·86 mm with the second method where arch width was measured between mesio-buccal cusps. Both techniques for calculation of arch perimeter were heghly reproducible. The catenary curve only approximated arch form well when the arch was relatively narrow across the inter canine region. For square arches this method was unsatisfactory. It is suggested that alternative techniques would be more reliable and the overlap method desribed here is considered satisfactory.


Journal of Orthodontics | 1996

Obstructive sleep apnoea: fact not fiction.

Joanna M. Battagel

Obstructive sleep apnoea (OSA) is a recognized clinical disorder in which periods of cessation of breathing occur in the presence of inspiratory effort. Because this may have serious cardio-vascular and pulmonary consequences, diagnosis, and adequate treatment are important. Apart from its medical repercussions, OSA adversely affects the quality of life of both the sufferer and his family. This paper aims to give an overview of the complaint, defining and describing the disorder, reporting its signs and symptoms, and discussing its diagnosis and treatment. Particular attention will be given to those areas in which the orthodontist may play an active role.


Journal of Orthodontics | 1994

Predictors of Relapse in Orthodontically-treated Class III Malocclusions

Joanna M. Battagel

This study aimed to investigate the possibility of predicting relapse from the pretreatment records of children with orthodontically treatable Class III malocclusions. Sixty-four patients were studied: 31 individuals had been treated by a non-extraction technique, the remaining 33 with mid-arch extractions. Cephalometric and model data taken at the start of treatment and at least 2 years after all treatment and retention had ceased were examined. An individual diagnosis of relapse or stability was made from the post-retention records and the start of treatment records analysed in relation to this information. The capacity for predicting the observed outcome of therapy was assessed in three ways: correlation coefficients, the number of cephalometric measurements exceeding two standard deviations from a control group mean, and discriminant analysis. Only the latter proved an effective indicator of relapse, with a separate discriminant model being necessary for each sub-group.


Journal of Orthodontics | 1983

The Management of Class III and Class III Tendency Occlusions Using Headgear to the Mandibular Dentition

Harry S. Orton; P. G. Sullivan; Joanna M. Battagel; Shelagh Orton

The use of extra-oral traction to the lower arch in the treatment of Class III malocclusion is described. The results of the treatment of 43 consecutive cases employing both removable and fixed appliances are analysed and compared with an untreated control group of 15 further cases. It was found that the Class III malocclusion in the study fell into three groups, the characteristic of each group giving an indication of the recommended treatment approach.


European Journal of Orthodontics | 2011

The use of videofluoroscopy in the assessment of the pharyngeal airway in obstructive sleep apnoea.

Ama Johal; Zahra Sheriteh; Joanna M. Battagel; Claire Marshall

This prospective cohort study evaluated the use of videofluoroscopy in assessing changes in both antero-posterior (A-P) and transverse pharyngeal airway dimensions in patients with obstructive sleep apnoea (OSA). Forty patients [32 males and 8 females; mean age of 49.3 (SD = 10.79) years] with confirmed OSA, referred for mandibular advancement appliance (MAA) therapy were recruited. Patients received a customized Herbst MAA, adjusted for maximum comfortable protrusion. A standard lateral cephalogram, supine A-P, and transverse videofluoroscopic investigations were performed. Repeat supine videofluoroscopic investigations were undertaken with the MAA in situ. Parametric tests were used to evaluate the study hypotheses as the data were normally distributed. A paired t-test was employed to determine both the impact of posture on the airway using upright cephalometry and supine videofluoroscopy and the effect of MAA insertion on A-P and transverse pharyngeal airway dimensions. Following a change in posture from upright to supine, highly statistically significant (P < 0.001) changes were observed for all lateral pharyngeal dimensions. Statistically significant increases in minimum lingual airway (P < 0.001) and maximum transverse pharyngeal airway (P < 0.001) were found following MAA insertion. A reduction in soft palate area (P = 0.029) and pharyngeal height (P < 0.001) was also noted. Videofluoroscopy offers a useful dynamic assessment of the pharyngeal airway in both the A-P and transverse planes in patients with OSA.


Journal of Orthodontics | 1994

Facial Growth of Males and Females Compared by Tensor Analysis

Joanna M. Battagel

This study compares and contrasts the longitudinal differences in facial development between 18 male and 22 female subjects, employing the technique of tensor analysis. Children were examined in two age ranges: prepubertal (aged 7–10 years) and post-pubertal (15–20 years of age). Both the changes over time and the differences in amount and direction of growth between the sexes were subjected to statistical analysis. A tensor analysis permits the computation of differences in form (that is in size and shape) without specifically measuring either. Mean values for 21 hard and soft tissue landmarks were determined for both males and females at each age. Customized computer software allowed examination of the growth changes between 32 selected groups of points. Results indicated that the tensor analysis reinforced and supplemented the more conventional descriptions of facial growth. Females grew a smaller amount over the period examined than their male peers and development was in a relatively more vertical direction. These differences in growth between the sexes were highly statistically significant.


Journal of Orthodontics | 1996

The Assessment of Crowding Without the Need to Record Arch Perimeter. Part I: Arches With Acceptable Alignment

Joanna M. Battagel

A simplified, mathematically determined technique for calculating arch perimeter (the overlap method) is described and its validity in determining an accurate assessment of crowding is tested. Indices, expressed in millimeters of crowding or spacing, were computed for both, the whole arch and the labial segment alone. Study casts of 36 individuals with, clinically acceptable lower arches were used to validate the method. The degree of crowding or spacing calculated was compared with a ‘clinical’ assessment of each arch, in which the irregularity was measured directly using a steel ruler. Various calculation schemes were tested. Depending on exactly how the overlap was determined, the results varied slightly. Although the arches showed acceptable alignment, it was preferable to include a strategy for normalizing the positions of any rotated teeth before the overlaps were calculated. Repositioning any bucco-lingually displaced teeth into the line of the arch, however, was not useful. For the complete arch good agreement with the clinical assessment was reached on 31 occasions and for the labial segment, all but one appraisals were within 0·5 mm of each other. In the remaining instances (five complete arches and one labial segment), the degree of crowding or spacing was between 0–5 and 1 mm of the clinical assessment Considering that clinical measurement of minor degrees of crowding and spacing cannot be precise, these results were considered acceptable. The method was easy to use, relying only on the recording of mesio-distal tooth widths and was acceptably reproducible. The technique would therefore appear to provide a valid yet simple research tool with winch to record the degree of crowding. Its ability to cope with irregular and crowded arches will be the subject of a subsequent review.

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Ama Johal

Queen Mary University of London

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Mark P. Hector

Queen Mary University of London

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Claire Marshall

Queen Mary University of London

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Zahra Sheriteh

Queen Mary University of London

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